1991, 06-17 Permit App 91003381 FurnaceMECHANICAL PERMIT APPLICATION FORM
/ Information Worksheet
S.
JOB STREET ADDRESS: /(/C
CITY/STATE/ZIP:/,,, 7���j�/ii, G� ?-'/-Z PARCEL NUMBER:
OWNER: /1�/1 C (/V/2/V PHONE NUMBER: - --33 330Z 7
MAILING ADDRESS: \,S. /Lf lG 0/7117/e) 6,4f//1%W
(Street) (City/State)
CONTRACTOR: LICENSE NUMBER:
MAILING ADDRESS:
(Zip)
PHONE NUMBER:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVEIiNSERT
GAS WATER HEATER
GAS EQUIPMENT ',;<100,000 BTU (INC:LUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
.......... ... ...........................
GAS PIPING (EA OUTLET)
BOILER/REFRIG 1-100M BTU
BOI LER/REPRIG:.1.01-500M .BTU
BOILER/REFRIG 501-1,000M BTU
BOILER/REFRIG 1; 0007=1;750M BTU;:
BOILER/REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0=3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP. & AIR CONDITIONER'15730 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP &'AIR CONDITIONER+50 TONS..:
VENTILATING FANS
EVAPORATIVE COOLER S;:
TYPE I HOOD (PER 12' OR 12' PIN. OF HOOD)
TYPE If HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000,BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x20.00 =
x 25.00 =
x35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
1
SUBTOTAL
$
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= S
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUV::BER:
MAILING ADDRESS:
(Street)
(City/State)
(Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
SINKS:
SHOWERS
..................................................................
BATH TUBS:
KITCHEN SINKS
.............................
DISH .WASHERS
GARBAGE DISPOSAL
................................................................ . .
CLOTHES<WASHER
UTILITY SINKS
........................................
ELECTRIC:WATER HEATERS
FLOOR DRAINS
FLOOR SINKS:..
BAR SINKS
..............................................
ROOF'€DRAINS
LAWN SPRINKLER
......:................................................... .
SEWAGE`: EJECTOR
WATER SOFTENER
................................................
URINAL
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
SUBTOTAL
S
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= S
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675